More shocking news for erectile function

While low sexual desire predominates as the main reason for the sexless marriage, it is quite common that this is precipitated by a loss of erectile function in her partner.  We are always looking for ways to improve sexual performance in both men and women, so today I will post on erectile function.  

Two years ago I presented "Shocking News on Erectile Function" and today I want to update you on the continued research.

A systematic review and meta-analysis was presented in the Journal of Sexual Medicine in January of 2017.  Included were 7, randomized, controlled trials using low-intensity extracorporeal shock wave therapy for erectile dysfunction.  

There were 602 participants in this study with an average age of 60 years old during a 20 week follow-up period.  A statistically significant improvement in erectile function was noted vs sham therapy (placebo).

 While we are all familiar with the successes of shock wave therapy for mood disorders - the idea of applying electrical current to the penis seemed like a horror to most - except, perhaps to the masochists among us.  But thanks to science and interested volunteers, the evaluation of this therapy continues.

Remember, the definition of ED is the inability to achieve or maintain an erection for satisfying sexual performance.  This is caused by aging and co-morbid conditions such as smoking, CVD and diabetes.  Other causes include sexual boredom, excessive pornography compulsivity and continued lack of enthusiasm by the female partner.  One in five men are affected.  While PDE5-I such as Viagra or Cialis help many, there are still those that are resistant to such therapy or cannot tolerate the side effects.

Low-intensity shock wave therapy is thought to improve neovascularization (new blood vessel growth).  Many studies done in the diabetic rat model initially led to discoveries that this therapy may lead to changes that regenerate penile tissue.  In rats, regeneration of the endothelial tissue, smooth muscle and nerves expressing nitric oxide synthase were noted.

In humans, no tissue biopsies or gene expression studies have been done, but increases in flow-mediated dilatation is reported.  This indicates improvement in blood flow and blood vessel endothelial function.

While exciting news, it is unclear where this low-intensity shock wave therapy will fit into the current algorithm for the management of ED.  It is not currently in the recommendations from the American Urological Association guidelines.  Stay tuned!